Action Needed: Identify what plans and family members the request pertains to

Outline why the request is necessary/what happened. Include details and supporting documentation pertinent to the missed enrollment deadline, that might influence the determination/resolution of the request

Have you accessed care? If yes, please provide the most recent date accessed.

The Campus Benefits Office will confirm receipt of the request within 24 hours or less and if we have all the pertinent details we should provide an answer within 7 business days or less. If approved, additional instructions will be provided for enrollment.